Jejunovesical Fistula Diagnosis After Normal Vaginal Delivery: A Case Report.

Enterovesical fistula represents an abnormal communication between the intestine and bladder. The causes are diverticulitis (56.3%), malignant tumours, which are located mainly in the intestine (20.1%), and Crohn's disease (9.1%). Other causes include iatrogenic injury (3.2%); trauma; foreign bodies in the intestinal tract; radiotherapy; chronic appendicitis; tuberculosis; and syphilis. Normal vaginal delivery as a cause for enterovesical fistula has not been reported in many publications yet. We report a case of a 30-year-old female, who developed an jejunovesical fistula after normal vaginal delivery. It was diagnosed after diagnostic cystoscopy and computed tomography of the abdomen and pelvis. There was jejuno-vesical fistula. Resection of the segment of the jejunum with side-to-side anastomosis with bladder repair was done. A follow-up cystogram was done which showed no contrast extravasation into the peritoneum. The patient was followed up for 9 months after surgery. Keywords: case reports; fistula; jejunum; urinary bladder.

Primary retroperitoneal solitary fibrous tumor: A case report.

Primary retroperitoneal masses have numerous differential diagnoses, many of which are rare entities. These can be neoplastic or nonneoplastic. Among the rare conditions are solitary fibrous tumors, which can either be benign or malignant. It is a mesenchymal, spindle-cell tumor, reported first in 1931 as a pleural tumor by Klemperer et al. A 20-year-old lady, with abdominal pain for 6 months, was diagnosed with a retroperitoneal mass on the left lower abdomen on USG which was confirmed by an MRI scan of the abdomen. The patient underwent laparoscopy-assisted excision of the mass. The final histopathological reports and immunohistochemistry reports revealed a solitary fibrous tumor. Solitary fibrous tumors (SFTs) are rare tumors in the retroperitoneum. In our search, fewer than a hundred cases have been reported. It has a characteristic "patternless pattern" in a microscopic study. Adverse outcomes of SFTs are associated with atypical features in histology, such as nuclear pleomorphism, necrosis, increased cellularity, and mitoses >4/10 HPF and size more than 10 cm. The standard of care is surgical excision with clear margins. Open surgeries have been done traditionally; we present a case where we performed the excision laparoscopically.

Traumatic gastric laceration with injury of splenic and celiac vessel following intentional self-harm by crashing of motor vehicle: A case report.

Intra-abdominal injury due to blunt trauma accounts for 5-10% of all traumatic cases. It usually occurs secondary to motor vehicle collision, pedestrian injury, and falls. Typically these result in injury to solid abdominal organs-liver and spleen, hollow visceral organs, and rarely the abdominal vasculature. Blunt abdominal trauma causing concurrent injury to the hepatic branch of the celiac artery and the associated vein along with gastric laceration is a rare presentation and has a high mortality rate, thereby warranting prompt evaluation. While the initial stabilization should follow Advanced Trauma Life Support guidelines, the adherence to nonoperative management or operative care depends upon the severity of the injury and the patient's clinical status. Here, we present an unusual case of gastric and splenic laceration with damage to the hepatic branch of celiac artery, splenic artery, and the associated vein following blunt abdominal trauma in a 12-year-old child following intentional self-harm by crashing a self-inflicted motor vehicle. Despite the negative preoperative radiological finding, the case was managed successfully with the laparotomic correction of the damaged stomach segment, splenectomy, and repair of the damaged artery, and ligation of the transected vein to control hemorrhage.

Spontaneous Common Femoral Artery Pseudoaneurysm: A Case Report.

Spontaneous femoral artery pseudoaneurysm in a young person with no comorbidity is a rare occurrence. A 30 years old gentleman presented to our hospital with complaints of painful swelling of spontaneous onset in the right inguinal region for 15 days. He had undergone incision and drainage of the contents of the swelling five days back but he suffered from a recurrence of the painful right inguinal swelling and persistent bleeding from the incision site for four days. Computed tomography showed a pseudoaneurysm of the right common femoral artery. It was treated surgically by emergency exploration, hematoma evacuation, removal of pseudoaneurysm, and repair of the defect in the right common femoral artery. In this case, we were fortunate that inadvertent incision of the pseudoaneurysm didn't result in a massive haemorrhage. This serves as a reminder that the possibility of a femoral artery pseudoaneurysm should be considered when evaluating a swelling of the inguinal region. Keywords: case report; common femoral artery; misdiagnosis; pseudoaneurysm; vascular surgery.

Radical Cystectomy for Intradiverticular Bladder Carcinoma: A Case Report.

Herniation of bladder mucosa through the bladder wall muscle layer is known as bladder diverticulum. The incidence of bladder diverticulum is 1.7. About 0.8 to 10% of the urinary bladder diverticulum develops carcinoma. Transitional cell carcinoma is the most common. Painless hematuria is the most common clinical presentation. Different imaging modalities along with cystoscopy are the key to accurate diagnosis and staging. High grade multifocal urothelial carcinoma in the bladder diverticulum is better managed by radical cystectomy and standard pelvic lymph node dissection with an ileal conduit. Here we report a case of a 66-year old gentleman of high grade multifocal urothelial carcinoma in bladder diverticulum managed with radical cystectomy and standard pelvic lymph node dissection with an ileal conduit. Such cases have been addressed adequately in the literature, but we did not find such cases from our country.

Disseminated infection with Nocardia otitidiscaviarum in a patient under steroid therapy.

Corticosteroid recipients with lung infections should be suspected of having nocardiosis; however, nocardiosis can easily mimic malignancy, tuberculosis, or fungal infection. Though cultural identification is possible, it might be missed due to its slow growth pattern.. Therefore, if filamentous bacteria are seen during staining, plate incubation time should be extended.

Impact of Miniaturization on Early Outcome of Percutaneous Nephrolithotomy.

BACKGROUND: Percutaneous nephrolithotomy has become the standard procedure for large renal stones but still remains highly challenging due to complications such as bleeding and sepsis, even though it has high stone free rate (SFR). We report the early outcomes of more than 1000 percutaneous nephrolithotomys done in our center. METHODS: A retrospective study of all patients undergoing percutaneous nephrolithotomy from January 2010 to December 2017 in single institution was conducted. All cases were stratified into three groups based on tract size; standard percutaneous nephrolithotomy with tract size ? 22 F, mini percutaneous nephrolithotomy with tract size 15 - 20 F and ultramini percutaneous nephrolithotomy with tract size ? 14 F. Age, gender, stone complexity using Guy's stone score, stone size, operative time, hemoglobin drop, hospital stay, early major and minor complications were reviewed. RESULTS: A total of 1074 patients had undergone percutaneous nephrolithotomy among which, 578 patients were standard percutaneous nephrolithotomy, 433 mini percutaneous nephrolithotomy and 63 had undergone ultramini percutaneous nephrolithotomy. There was even distribution of patients with Guy's stone score 1 and 2 in all three groups. However, majority of patients with Guy's stone score 3 underwent standard percutaneous nephrolithotomy or mini percutaneous nephrolithotomy and no patients with Guy's stone score 4 underwent ultramini percutaneous nephrolithotomy. Age group, gender and operative time were comparable between the groups; however, significant difference was noted in terms of less hemoglobin drop and shorter hospital stay (p-value < 0.05) in the miniaturized percutaneous nephrolithotomy group. Complications were found to be fewer in mini percutaneous nephrolithotomy and ultramini percutaneous nephrolithotomy group in comparison to standard percutaneous nephrolithotomy. CONCLUSIONS: Miniaturization of tract size significantly decreases post-operative complication rates, blood loss and hospital stay while maintaining high stone free rates in well selected patients undergoing Percutaneous nephrolithotomy.